Muscle computed tomography (CT) and muscle strength assessment of the pelvic girdle and leg muscles were performed in 32 postpolio patients experiencing new muscle weakness, and in 13 postpolio patients with stable neuromuscular condition. Muscles of the postpolio patients experiencing new muscle weakness showed significantly more CT scan abnormalities as compared with the stable postpolio patients. No other features discriminative of symptomatic postpolio patients were found. In individual patients, muscle CT scan evaluation is a useful adjunct to muscle strength assessment.
"Electromyography may show subclinical involvement, with enlarged motor units in clinically unaffected muscles indicating a subclinical involvement during the acute illness. More than 50% of the motor neurons within one spinal cord segment must be destroyed before a weakness can be detected clinically.18 Ivanyi et al showed that a computed tomography (CT) scan of polio muscles may be helpful to explore the muscle abnormalities, and thereby supplying clinical and neurophysiologic examinations.19 Whether magnetic resonance imaging (MRI) can be helpful to detect anterior horn abnormalities in PPS remains to be investigated in future studies. "
[Show abstract][Hide abstract] ABSTRACT: Post-polio syndrome (PPS) refers to the clinical deterioration experienced by many polio survivors several decades after their acute illness. The symptoms are new muscle weakness, decreased muscle endurance, fatigue, muscle pain, joint pain, cold intolerance, and this typical clinical entity is reported from different parts of the world. The pathophysiology behind PPS is not fully understood, but a combination of distal degeneration of enlarged motor units caused by increased metabolic demands and the normal aging process, in addition to inflammatory mechanisms, are thought to be involved. There is no diagnostic test for PPS, and the diagnosis is based on a proper clinical workup where all other possible explanations for the new symptoms are ruled out. The basic principle of management of PPS lies in physical activity, individually tailored training programs, and lifestyle modification. Muscle weakness and muscle pain may be helped with specific training programs, in which training in warm water seems to be particularly helpful. Properly fitted orthoses can improve the biomechanical movement pattern and be energy-saving. Fatigue can be relieved with lifestyle changes, assistive devices, and training programs. Respiratory insufficiency can be controlled with noninvasive respiratory aids including biphasic positive pressure ventilators. Pharmacologic agents like prednisone, amantadine, pyridostigmine, and coenzyme Q10 are of no benefit in PPS. Intravenous immunoglobulin (IVIG) has been tried in three studies, all having positive results. IVIG could probably be a therapeutic alternative, but the potential benefit is modest, and some important questions are still unanswered, in particular to which patients this treatment is useful, the dose, and the therapeutic interval.
[Show abstract][Hide abstract] ABSTRACT: The research on post-polio syndrome in Amsterdam started in 1989 and was initiated by professor Marianne de Visser, neurologist. From that time on increasing numbers of Dutch patients with post-polio syndrome came to the AMC Amsterdam. Post-polio research has continued in Amsterdam, led by Marianne de Visser, Anita Beelen and Frans Nollet, resulting in 29 peer reviewed scientific papers up till now. PhD theses were written by Barbara Ivanyi in 1999, Frans Nollet in 2002, Herwin Horemans in 2005, Merel Brehm in 2007, and Janneke Stolwijk-Swüste in 2009. At present 4 PhD students in the Dept of Rehabilitation are doing research in the field of polio. Research focuses on clinical studies. Some results are summarized and can be categorized as: I Epidemiological and longitudinal studies II Diagnostic studies III Physiological studies IV Intervention studies V Methodological studies Epidemiological and longitudinal studies Polio victims from the last large epidemic in The Netherlands in 1956 with almost 1800 cases were studied 39 years later. In this population-based study among 260 respondents almost 60% experienced signs of new weakness, increased disabilities and handicaps and diminished health- related quality of life. The use of devices and adaptations had increased.(8,12) A cohort of 103 polio patients was followed for six years. 27 of them had stable polio and 76 post-polio syndrome.(7,14) It appeared that health-related quality of life of the patients with PPS was lower compared to the stable functioning polio individuals. Over the years physical functioning did not change much. However, it appeared that the severity of paresis at baseline was a prognostic factor for decline in physical functioning in six years. These results supported the concept of overuse, that a (slow) decline in muscle mass, as a late effect of polio, may lead to a decline in physical functioning as the reduced muscle capacity becomes less able to meet the demands of daily physical activities. In a systematic review of the literature we concluded that so far no conclusions can be drawn from the literature with regard to the functional course or prognostic factors in late-onset polio sequelae.(23) The rate of decline in muscle strength is slow, and prognostic factors have not yet been identified. Long-term follow-up studies with unselected study populations and age- matched controls are needed, with specific focus on prognostic factors. Therefore we are presently conducting the CARPA-Polio study (Comorbidity and Aging Effects in Rehabilitation Populations on Activities). The longitudinal CARPA study focuses on the effects of aging and co-morbidity on functioning over time in 3 patients groups: Polio, M Parkinson, hip and knee osteoarthritis. The CARPA-Polio cohort includes 168 polio individuals.(26) Individuals range in age between 45 and 85 years and in contrast with many other studies, co-morbidities are not excluded but its influence on the time course is studied to reflect what happens in reality with aging. At the moment the participants in the study have been followed for 5 years. Some results have been published and included in the thesis by Janneke Stolwijk-Swüste. Age and co- morbidities were found to be negatively associated with physical functioning and physical independence. The influence of these factors on the changes over time is limited.(31) More
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